放置前预处理对于LNG-IUS治疗症状性腺肌病效果的影响  

Impact of pre-treatment with GnRHa on the effects of LNG-IUS for symptomatic adenomyosis

作　　者：李雷[1] 冷金花[1] 贾双征[1] 张俊吉[1] 李晓燕[1] 史精华[1] 刘真真[2] 游姗姗 常晓燕[3] 郎景和[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院超声科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《现代妇产科进展》2016年第5期337-341,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:分析症状性腺肌病患者放置左炔诺孕酮宫内缓释系统(LNG-IUS)前应用促性腺激素释放激素激动剂(GnRHa)预处理对于治疗效果的影响。方法:2006年12月至2014年12月北京协和医院妇产科对门诊或住院部通过超声诊断为子宫腺肌病的重度痛经和(或)经量过多的1100例患者给予LNG-IUS治疗,其中378例(34.4%)患者在放置LNG-IUS前应用GnRHa(预处理组),其他患者为对照组。放置前后不同随访时间点评估患者的携带状态、痛经症状、疼痛评分、出血评分、生化指标、体格参数、月经模式及不良反应,分析放置LNG-IUS前应用GnRHa预处理对于治疗效果、不良反应、月经模式以及续带率的影响。结果:预处理组GnRHa中位应用次数为3次(范围1~5次)。预处理组和对照组在60个月的累积续带率分别为74%和63%(P<0.001),脱落率分别为10.8%和18.7%(P=0.001)。放置3~60个月期间,预处理组和对照组的治疗效果、月经模式改变、总体不良反应发生率、不同类型的不良反应发生率等指标均无显著差异。结论:症状性腺肌病患者放置LNG-IUS前予以GnRHa预处理治疗可以提高续带率,降低脱落率,但并不改善治疗效果和不良反应。Objective:To investigate the impact of pre-treatment with GnRHa on the effects of levonorgestrel-releasing intrauterine system(LNG-IUS)for symptomatic adenomyosis in a prospective cohort study.Methods:From Dec.2006 to Dec.2014,1100 patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital received the treatment of LNG-IUS.378 cases(34.4%)received GnRHa before placement of LNG-IUS as pre-treatment group,while other cases belonged to control group.Before and after placement of LNG-IUS,all the parameters of each visit were recorded prospectively,including carrying status of IUS,symptoms and scores of dysmenorrhea,menstruation scores,biochemical indicators,physical parameters,menstruation patterns and adverse effects.Impact of pre-treatment with GnRHa on the treatment effects,changes of menstruation patterns and carrying status of LNG-IUS were analyzed.Results:In pretreatment group,median cycles of GnRHa was three times(range 1 ~ 5).On 60 months the ac-cumulative carrying ratio of LNG-IUS were 74% and 63% in pre-treatment group and in control group respectively(P<0.001),and expulsion ratio were 10.8% vs 18.7%(P = 0.001).From3 months to 60 months,there were no significant differences between pre-treatment group and control group about menstruation patterns,adverse effects in total or in subclass.Conclusion:Pre-treatment with GnRHa before placement of LNG-IUS for symptomatic adenomyosis could increase carrying ratio and reduce expulsion ratio,but couldn't improve treatment effects or reduce adverse effects.

关 键 词：左炔诺孕酮宫内缓释系统 子宫腺肌病 促性腺激素释放激素激动剂 避孕器脱落 

分 类 号：R711.71[医药卫生—妇产科学]